Insurance Verification Representative (H)

University of Miami•Medley, FL

2d•Onsite

About The Position

The Insurance Verification Representative is responsible for verifying patient insurance eligibility and benefits to ensure proper authorization and referral activities are completed prior to the patient's date of service. This role involves direct interaction with patients, healthcare providers, and insurance companies to facilitate the financial clearance process and provide excellent customer service within the UHealth system.

Requirements

Demonstrated knowledge of insurances, including authorization/referrals guidelines and requirements.
Demonstrated ability to communicate effectively in written and verbal form.
Demonstrated ability to communicate effectively with physicians, customers, teammates, and other staff.
Ability to interact and assist patients of all ages, cultural backgrounds, and with special needs, with a passion for providing excellent service and care.
Ability to work under a high level of stress with time constraints while maintaining composure and sensitivity to each patient’s specific needs.
Maintain a high level of diplomacy when dealing with stressful situations.
Is innovative, proactive, and resourceful in problem-solving.

Nice To Haves

Bi-lingual knowledge a plus

Responsibilities

Verify eligibility and benefits via RTE in UChart, online insurance websites, telephone, or other automated services.
Add and/or edit insurance information in UChart, validating guarantor accounts, plan details, subscriber information, policy numbers, claims addresses, and plan order.
Complete checklists and document co-pays.
Create referrals (e.g., "Benefit only" or "Preauthorization") and document benefit information such as deductible, co-insurance, and out-of-pocket benefits.
Meet productivity standards for assigned work queues, achieve a QA goal of 95% or greater, and maintain work queues current at 14 days out with minimum daily pending visits.
Assist in educating patients and act as a resource to patients, primary care, and specialty care practices within the UHealth system and externally.
Contact Primary Care Physician offices and/or Health Plans to obtain authorization or referral for scheduled services according to authorization guidelines in the UHealth Contract Summary.
Submit all necessary documentation required to process authorization requests.
Obtain authorization for both facility and provider for POS 22 and POS 19 clinics, and provider only for POS 11 clinic locations.
Enter and attach authorization information in the referral section of UChart.
Approve referrals and financially clear visits.
Communicate with patients and/or departments regarding authorization denials or re-directions by health plans or PCP offices.
Contact departments and/or patients when additional information is required or to alert them about pending authorization status.
Participate in process improvement initiatives.
Provide customer service and assist patients and other UHealth staff with insurance-related questions according to departmental standards.
Ensure patients are aware of issues regarding their financial clearance and are educated on the referral/authorization process.
Collaborate with Department and Patient Access teams to ensure timely and concise communication.
Ensure service recoveries and escalations are implemented with supervisor guidance and according to departmental standards and guidelines.
Perform other duties as assigned.